Continuation of the discussing the care and management done to an antepartal woman and we’ve moved on to conducting pelvic

examination.

With that, we tackled the topic of Pap smearing or what we call papanicolau smear in full term. It can be also referred to a pap test whereas it is
a test to see if a woman has cervical cancer. This is done by collecting cells from the cervix. The result of this test has different outcomes and it
can classified as
class 1: normal,
Class II-A: Acytology but no evidence of malignancy,
Class II-B There is a suggestive inflammation in the cervix.
Class III: It indicates that there is a cytology suggestive of malignancy
Class IV: Cytology strongly suggestive of malignancy
Class V: Cytology conclusive for malignancy.

When malignant and our client is positive of cervical cancer, it can be in stages 0 to 4.
stage 0: is carcinoma in situ whereas the abnormal cell that is possible to be a cancer cell is only found where they are first formed.
Stage 1: is strictly confined to the cervix
Stage 2: From cervix, it metastasized in the vagina
Stage 3: It already metastasized in the pelvic and
Stage 4: It already spread to the bladder and rectum.

After this, we sort of went into a review of Leopold’s maneuver. The four maneuver or grip, the FUPP GRIP, Fundal, Umbilical, Pawlick, Pelvic.
Fundal is done to determine the uterine fundus level and its fetal presentation.
Umbilical grip is done to determine the fetal position
Pawlick’s grip is done to check if the head is engaged or not
and lastly the Pelvic grip which is done to determine the degree of the fetal’s head flexion.

Moving on, we also discussed the things that we do to conduct antepartum fetal surveillance. These involves many different methods and four
of those are discussed last week namely, Daily Fetal Movement Counting, Non-Stress Test, Oxytocin Challenge Test and Biophysical Profiling.

As reference, the physiology of normal third trimester fetal movement involves the fetus making gross movement 10% of its time, whereas the
active fetal periods last for about 40 minutes, and 20 minute for inactivity. It is also normal for fetal activity to peak as the mother experience
hypoglycemia and that’s the reason behind why the baby’s more active at night as the mother’s sugar is low that time.

DONE, NORMAL FINDINGS, DANGER FINDINGS.

1.) Moving on, one of the thing that we can do is Conduct Daily fetal Movement Count.

- It is done by the mother self-monitoring at home in which it should be conducted at the same time each day. It is done at a time whereas the
baby is the most active and when the test is done, the mother should be on a comfortable location and is lying on her left side. The test is done
by measuring the time it takes for the fetal movement to reach 10.

- A healthy baby should make about 10 movements per hour and taking more than that warns us that we could be experiencing a problem as
there is a deviation from the norms.

- Other than that, we should be more alarmed whenever there is less than 10 fetal movement in 12 hours, we should be alarm whenever it takes
a longer time to reach 10 fetal movements than those of those in the previous days and movement are becoming weaker.

- If this warning signs are encountered, further testing is done such as Non-stress test and et cetera.

2.) Next is Biophysical Profiling. In a nutshell, it determines the ultrasound monitoring of fetal movements, fetal tone and fetal breathing,
ultrasound assessment of liquor volume with or without assessment of the fetal heart rate. Here we can find out if there is too much or too little
accumulation of amniotic fluid.

3.) Third is the Non-stress test which determines the response of the fetal heart rate to the stress of activity.

- It is done in a span of 30 minute whereas the mother is in Semi-fowler’s position. Here, we use external monitors are applied to document fetal
activity. This monitors include tocotransducer placed over fundus to recognize uterine contractions and FM whilst ultrasound transducer in the
other hand is over the abdominal site to detect fetal heart tone.

- A mark button is activated by the mother whenever she feels fetal movement and we would be monitoring up until 2 fetal momvenets is
detected in 20 minutes.

- In a summary, the results of this test can either be reactive which indicates normalcy and non-reactive in which it is negative result.

4.) Lastly, the surveillance method that we can do is Oxytocin challenge test. This is done by simply IV infusing diluted oxytocin until three
contraction occurs within ten minute. On the contrary, we can also just simply stimulate the nipples for whenever we do it, oxytocin is release
and it induces increase fetal heart rate and contracts.

Other than those, as nurses we should be conducting Health Teaching such as the Frequency of prenatal visit they should be committing to and
the danger signs that their pregnancy could be in danger
Frequency in visitation is:
1-7 months – once a week
8-9 months – twice a week
10th month – Every week
Post term – Twice A week.

Danger signs on their pregnancy is SCABS

S- swelling
C – Chills and fever
A – abdominal Pain
B – Board like abdomen, blurred vision, BP elevation, bleeding
S – Sudden gush of blood.

Other than those, we should also be teaching that sexual activity should be done in moderation and remind them some vital things that
remember whenever the partner is already pregnant.
- Sexual activities should be done in a private place, comfortable position and this must be avoided 6 weeks prior to estimated date of delivery
and even though our partner aint pregnant, we should be avoiding blowing of air in cunnilingus as it can produce air embolism.

- Further reminders are done if contraindications are present such as vaginal spotting and preterm labor.

As there is also this general notion that pregnant woman shouldn’t move to avoid experiencing “makunan” we should also teach them that
doing exercises helps with pregnancy. That is strengthens muscles that they would be using during birthing.

Lastly, we should be also preparing the parents for childbirth physically and psychologically. We tackled three different ways of child birth
preparation. The psychophysical, psychosexual and psychoprophylaxis.

The psychophysical has two methods; the Bradley method and grantly dick read method.

The Bradley model in leiman’s term is just the male partner coaching his partner, encouraging her to deliver the baby, grantly dick read method
in the other hand is the involvement of certain types of relaxation to remove tension.

Psychosexual is what we also call kitzinegr method by dr shiela kitzinger. In a nutshell, her method just suggests how the mother should go with
the flow of contraction..

Lastly is the psychoprophylaxis whereas it is the mix of the husband being the coach to help partner to relax.
The last topic that we’ve discussed is one of the delivery method done. This is the leboyer’s method or birth under water which is common in
USA, japan and et cetera. This is done since the baby’s environment inside the stomach is fluid and so, they can easily adapt to the environment
whenever they are finally birthed.